Cardiovascular risk management in rheumatoid arthritis and other types of inflammatory arthritis: Current insights and gaps?

There is, during the last decades, increasing evidence that inflammation plays anessential role in all stages of atherosclerosis, ranging from endothelial cell dysfunction,foam cell and fatty streak formation, plaque destabilization with rupture, thrombosis andinfarction as the ultimate consequences. Therefore, it could be hypothesized that patientswith chronic inflammatory diseases are more prone for (accelerated) development ofcardiovascular disease in comparison to the general population. This would particularlyhold for rheumatic disorders with a high inflammatory burden such as rheumatoidarthritis, ankylosing spondylitis and psoriatic arthritis. Indeed, there appears to beevidence for an increased, approximately doubled, cardiovascular risk in theseinflammatory arthritis patients. Recent research indicated that "traditional"cardiovascular risk factors only partially explain this enhanced risk, and obviously, theother important reason is the underlying chronic inflammatory process that renders ourpatients more susceptible for the development of atherosclerosis.In view of the amplified cardiovascular risk, cardiovascular risk management ismandatory and this should on one hand consist of assessment (and treatment if necessary)of the traditional cardiovascular risk factors and on the other hand of effectiveantirheumatic treatment.